Telemedicine has been around for well over a century, depending on how broadly you define it. Military doctors transmitted casualty lists and ordered medical supplies by telegraph during the Civil War in the 1860s, and it’s likely some of those early telegraph exchanges involved medical consultations. The practice gained its formal name in the 1970s, but the core idea of delivering medical care across a distance has evolved through every major communications technology since the telegraph.
Telegraph and Telephone: The 1800s to 1940s
The earliest forms of telemedicine were simple out of necessity. During the Civil War, the U.S. military used telegraph lines to coordinate medical supply orders and relay lists of wounded soldiers. While no formal records document specific diagnostic consultations over telegraph, historians consider it probable that doctors sought and gave medical advice through the technology when no other option existed.
The telephone, once widely adopted in the early 1900s, became a routine tool for doctors communicating with each other and with patients. But the first documented case of transmitting actual clinical data over a phone line didn’t come until 1948, when doctors in West Chester, Pennsylvania, began sending X-ray images by telephone to colleagues in Philadelphia, 24 miles away. That project became the first reference to telemedicine in the medical literature when it was published in 1950.
Television Enters the Exam Room: The 1960s
The real leap happened when closed-circuit television made it possible for a doctor to see a patient in real time from miles away. The most famous early example launched in April 1968, when Massachusetts General Hospital opened a telediagnosis clinic connected to Boston’s Logan International Airport. A physician named Kenneth Bird set up a line-of-sight microwave transmission link between the two sites, about three miles apart.
The setup was remarkably sophisticated for its era. Cameras at the airport clinic could capture wide shots for physical examinations and close-ups for detail. Specialized equipment transmitted X-rays, heart tracings, and even video microscopy of blood smears back to a console in the hospital’s emergency department. The Boston Globe reported at the time that “the doctors are never more than a few feet away from their patients, even though the latter are at the airport and the doctors are at the hospital downtown.” This wasn’t a concept demo. It was a functioning clinical station that saw real patients for several years.
NASA and Remote Communities: The 1970s
The term “telemedicine” itself was coined in the 1970s by Thomas Bird, an American researcher. It combines the Greek word “tele,” meaning distance, with the Latin “medicus,” meaning healing. By that point, the practice already had a decade of serious investment behind it, largely driven by NASA.
Between 1961 and 1972, NASA developed systems to monitor astronauts’ heart rate, breathing, and blood pressure from the ground, along with live videoconferencing and direct lab analysis. Having built this technology for space, the agency wanted to test it on Earth. The result was STARPAHC, short for Space Technology Applied to Rural Papago Advanced Health Care, which ran from 1973 to 1977 on the Tohono O’odham reservation in southern Arizona.
The reservation’s extreme remoteness made conventional healthcare delivery impractical, so medical staff in towns like Sells and Santa Rosa were equipped with high-resolution cameras and trained to perform remote assessments. Doctors at distant facilities could evaluate patients through the video link. The program worked clinically, but providers ultimately found the technology too costly and time-consuming to sustain once NASA’s funding ended. It was a pattern that would repeat for decades: telemedicine proving medically effective but financially unsustainable with the technology of the time.
Store-and-Forward and Early Internet: The 1990s
As digital imaging and the internet matured in the 1990s, a new model emerged called “store and forward.” Instead of requiring a live video connection between doctor and patient, a clinician could capture images or data, transmit them electronically, and have a specialist review them later. A virtual dermatology clinic at the VA Medical Center in Poplar Bluff, Missouri, launched in 1997, was a typical example. Nurses photographed suspicious skin lesions during an exam, then transmitted the digital images to dermatology specialists in Columbia for evaluation. The specialist never interacted with the patient in real time, but could still provide a diagnosis.
Medicare took its first formal step toward covering telemedicine with the Balanced Budget Act of 1997, though the rules were restrictive. Patients had to be located in a designated rural area and had to travel to a clinic, hospital, or other approved medical facility to receive the service. You couldn’t use telemedicine from home, and you couldn’t use it in a city. These limitations kept telemedicine a niche tool for rural and veterans’ healthcare systems for the next two decades.
The Pre-Pandemic Reality: 2010 to 2019
Despite steady improvements in video calling, broadband access, and smartphone technology throughout the 2010s, telemedicine remained a sliver of American healthcare. As of 2019, telehealth accounted for just 0.1% of all private insurance and Medicare claims nationally. The technology was ready, but the regulatory and reimbursement framework wasn’t. Most insurers paid less for virtual visits than in-person ones, many states restricted which providers could practice across state lines, and Medicare’s rural-only, facility-only rules kept most beneficiaries from accessing it at all.
The Pandemic Surge: 2020 and After
COVID-19 transformed telemedicine from a footnote into a pillar of healthcare delivery almost overnight. In March 2020, Medicare waived its geographic and location restrictions, allowing patients to receive telehealth services from home for the first time. Private insurers followed. Among 36 million working-age adults with private insurance, telemedicine encounters jumped 766% in the first three months of the pandemic. Telehealth went from representing 0.3% of all healthcare interactions in early 2019 to 23.6% of interactions during the same period in 2020.
The spike didn’t hold at those levels. As in-person care resumed, telehealth settled to around 5% of all claims by the end of 2021. That’s still 50 times higher than the pre-pandemic baseline, representing a permanent shift in how millions of people access care.
Where Telehealth Policy Stands Now
Several pandemic-era telehealth expansions have become permanent features of Medicare. Audio-only mental health visits for patients at home are now permanently covered. Geographic and location restrictions for behavioral health telehealth services were permanently removed through the Consolidated Appropriations Act of 2021, meaning you no longer need to be in a rural area or drive to a clinic for a therapy session over video.
Other expansions remain temporary. The broadened list of providers who can bill Medicare for telehealth, including physical therapists, occupational therapists, and speech-language pathologists, was extended only through March 31, 2025. The policy landscape is still evolving, with some services locked in and others subject to renewal debates each budget cycle.
From Civil War telegraphs to smartphone video calls, telemedicine has been around in some form for over 160 years. But its practical reach for most patients is really a product of the last five years, when regulatory barriers finally dropped and both doctors and patients discovered that many types of care work just fine without sharing the same room.